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Thromb Haemost 2015; 113(01): 13-19
DOI: 10.1160/TH14-05-0416
Review Article
Schattauer GmbH

Diagnosis and management of non-criteria obstetric antiphospholipid syndrome

Deepa R. Jayakody Arachchillage
1   Haemostasis Research Unit, Department of Haematology, University College London, London, UK
2   Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
,
Samuel J. Machin
1   Haemostasis Research Unit, Department of Haematology, University College London, London, UK
,
Ian J. Mackie
1   Haemostasis Research Unit, Department of Haematology, University College London, London, UK
,
Hannah Cohen
1   Haemostasis Research Unit, Department of Haematology, University College London, London, UK
2   Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
› Author Affiliations
Further Information

Publication History

Received: 09 May 2014

Accepted after minor revision: 05 September 2014

Publication Date:
27 November 2017 (online)

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Summary

Accurate diagnosis of obstetric antiphospholipid syndrome (APS) is a prerequisite for optimal clinical management. The international consensus (revised Sapporo) criteria for obstetric APS do not include low positive anticardiolipin (aCL) and anti β2 glycoprotein I (aβ2GPI) antibodies (> 99th centile) and/or certain clinical criteria such as two unexplained miscarriages, three non-consecutive miscarriages, late preeclampsia, placental abruption, late premature birth, or two or more unexplained in vitro fertilisation failures. In this review we examine the available evidence to address the question of whether patients who exhibit non-criteria clinical and/or laboratory manifestations should be included within the spectrum of obstetric APS. Prospective and retrospective cohort studies of women with pregnancy morbidity, particularly recurrent pregnancy loss, suggest that elimination of aCL and/or IgM aβ2GPI, or low positive positive aCL or aβ2GPI from APS laboratory diagnostic criteria may result in missing the diagnosis in a sizeable number of women who could be regarded to have obstetric APS. Such prospective and retrospective studies also suggest that women with non-criteria obstetric APS may benefit from standard treatment for obstetric APS with low-molecular-weight heparin plus low-dose aspirin, with good pregnancy outcomes. Thus, non-criteria manifestations of obstetric APS may be clinically relevant, and merit investigation of therapeutic approaches. Women with obstetric APS appear to be at a higher risk than other women of pre-eclampsia, placenta- mediated complications and neonatal mortality, and also at increased long-term risk of thrombotic events. The applicability of these observations to outcomes in women with non-criteria obstetric APS remains to be determined.

Keywords

Antiphospholipid syndrome - international consensus criteria - obstetric APS - low titre aPL - recurrent miscarriages - heparin - aspirin
 

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